EMS During a War on Terror

May 23rd, 2013

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One of the striking images emerging from the Boston Marathon terrorist attacks was the photograph of the suspect receiving medical care from an ATF officer immediately after his arrest. The grainy image shows a severely injured Tsarnev handcuffed as a field dressing is placed on his neck with what appears to be a breathing tube in his airway. The officer, completely covered in military green down to his medical gloves, kneels next to a medical bag marked “Police,” its contents spilling onto the grass. This is the newest face of Emergency Medical Services (EMS) in America.

Terrorists have many tools at their disposal, but nearly all of their methods result in injured and sick people. Our EMS systems, as first responders for victims, are beginning to reflect this very real threat. When I first became an emergency medical technician in post-9/11 America, I received training in donning positive pressure isolation suits in the event of a biochemical attack. Alongside these suits, each EMT received an Epi-Pen-like auto-injector loaded with the words “FOR USE IN NERVE AGENT POISONING ONLY” printed on the side. Other stations received ambulance covers to protect against nuclear fallout. These tools show that EMTs no longer can wait until “the scene is safe” to start a response effort, as some incident scenes may never stabilize. While these tools and training cover EMS operations during biochemical events, we know that terrorists can have devastating effects without using biochemical tactics. EMS training and protocols should be expanded to cover operations under other dangerous conditions.

As terrorists continue to target American civilians and landmarks, EMS plays a crucial role alongside law enforcement. When the blasts hit Boston Marathon spectators, bystanders, law enforcement, and healthcare providers knelt next to victims to treat wounds before the smoke had even cleared. Their immediate actions saved many, despite a threat of secondary explosions targeting first responders.

While their actions were heroic and life-saving, it may be surprising to find out such actions are outside current response protocols, which dictate law enforcement and bomb squads declare a scene safe before EMS starts the triage, treatment, and transport of patients. The time necessary to sweep a city block, a building, or any other potential target is significant, and will cause more deaths as medical care is delayed for severely injured victims. Such a delay may be unnecessary, if EMTs and paramedics are trained to operate with law enforcement in such a way that ensures rapid medical attention to victims while minimizing secondary casualties. Like the ATF officer who carried medical equipment with him during the takedown of the Boston terrorist, law enforcement officers are already trained in field-based emergency medicine, but EMS personnel are rarely trained in law enforcement tactics. Currently, some “tactical EMS” courses are being offered, but they are the exception, not the norm.

While EMS shouldn’t necessarily carry firearms or make arrests, there is a greater need to interface and integrate into law enforcement activity. EMS should receive training on how to safely operate under hazardous conditions such as bombing sites or active shooter scenes. This may mean learning to identify secondary devices or maintaining cover while treating victims, to name just a few scenarios. Such skills will allow EMS to treat victims quickly and safely while law enforcement secures a scene.

As civilians are directly targeted by terrorists, our strategies to mitigate the impact of attacks must change. A greater tactical EMS presence immediately after attacks, or during counter-attacks, can reduce mortality and provide medical support for law enforcement teams.

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